Healthcare Provider Details

I. General information

NPI: 1386756153
Provider Name (Legal Business Name): SOUTHWEST COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date: 01/10/2023
Reactivation Date: 02/07/2023

III. Provider practice location address

1700 WATERMAN
DETROIT MI
48209-2022
US

IV. Provider business mailing address

1700 WATERMAN
DETROIT MI
48209-2022
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-8900
  • Fax: 313-841-2276
Mailing address:
  • Phone: 313-841-8900
  • Fax: 313-841-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMPHY NEGRON
Title or Position: DIRECTOR OF CLINICAL INFORMATICS
Credential:
Phone: 313-497-4986